New interventional neuroradiological procedures in Serbia: The direct costs of classical neurosurgical intervention in relation to the endovascular treatment of intracranial aneurysms

Abstract

Introduction: Intracranial aneurysms are one of the major causes of the neurosurgical morbidity and mortality. Each new therapeutic method, in relation to the standard one, generates high medical costs, as a rule. There have not been estimate of costs of treatment of intracranial aneurysms in Serbia. Objective: The aim of this study was to compare direct medical costs of clipping the neck of the aneurysm in relation to the new neuroradiological technique based on filling the aneurysmal sack with platinum coils and/or stenting the neck of the aneurysm. Methods: In a study approved by the Ethics committee of the Belgrade School of Medicine, we retrospectively measured the direct costs of treatment of bleeding and nonbleeding aneurysms at the Clinic of Neurosurgery, Clinical Centre of Serbia (CCS) in 2010. The study included a total of 300 patients divided in two groups: 1) study group included 99 patients with embolized aneurysms and 2) control group included 201 patients who were operated on by classical neurosurgical technique. Direct medical costs were calculated by the methodology of the State Health Care Insurance Fund. Analysis of results was performed using a software package SPSS. Results: Endovascular treatment was associated with 3% of adverse effects, lower mortality (2% vs. 2.9%), significantly shorter length of hospital stay (Z = - 8.566; p < 0.01), longer duration of anesthesia (226.7 to 195.2 minutes) and significantly higher costs (Z = - 12.475; p < 0.01) compared to neurosurgical treatment. A significant difference in costs was determined mainly by the price of embolization material, 328,169 RSD per patient (3,111€), and the number of resolved aneurysms (more than one, when the multiple aneurysms were treated). Conclusion: The procedural costs of embolization technique are high, as opposed to small number of hospital days. The readiness of the State Health Care Insurance Fund to pay for the costs of embolization should be approved following cost-utility analysis of both modalities, for the longer period of time.